Article Highlights

• Home health patients are trending toward using insurance, not traditional Medicare.
• Intake and insurance verification is critical when working with third party payers.
• Let PMB serve as your home health intake coordinator to receive payment for services.

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Home health agencies have a lot to consider before ever providing services to patients. Because of the increased rate of home health patients using insurance — rather than traditional Medicare — agencies need to spend more time focusing on their intake process to ensure that they are lined up to provide services that will be covered by insurance. Otherwise, you risk not receiving payment for services provided.

Needless to say, completing home health intake and insurance verification is very time-consuming. This is because dealing with insurance companies is very different than dealing with Medicare. There are many steps required to obtain insurance verifications and authorizations for patients that will be billed as a third-party payer and not traditional Medicare.

Some of the key steps involved in intake and insurance verification include the following:

• Finding out what kind of insurance a patient has.
• Discovering the general benefits that the patient has on their insurance plan.
• Discovering the specific type of home health benefits the patient has.
• Understanding which specific home health services are covered vs. not covered.
• Learning what the patient’s financial responsibility is, if any.

Because the goal of home health agencies is to get a patient better, get them out of the house, get them mobile, and help them not be homebound anymore, there is a natural sense of urgency to complete the intake process as quickly as possible. But, if your agency lacks efficient processes or if your team is not fully trained on intake and insurance verification, you could slow down the provision of services.

That’s why to achieve success providing services and to eventually receive payment for services, you need the support of a home health virtual intake coordinator.

Why Utilize a Home Health Intake Coordinator?

A home health virtual intake coordinator, such as Precision Medical Billing (PMB), can help home health agencies receive upfront approval for certain services when the patient is using insurance.

For example, a patient may be able to have up to 60 visits per year. Once those visits are up, your agency cannot go over the limit, otherwise you won’t receive payment for additional services.

Therefore, it’s important to understand upfront how many visits your agency can schedule during the patient’s care. This will depend on the limits set by the insurance company and how many visits the patient has already used. You need to gather this information so that you can strategically utilize the allotted patient visits to provide the best possible care, while also making sure your agency is positioned to receive payment.

Plus, your agency will sometimes have to receive prior approval to use the allotted visits. This requires conversations with the insurance company to verify that the services you believe should be provided to the patient will actually be covered by insurance. Coordinating this upfront is critical to make sure you receive payment for the services provided and are not denied payment for services that are not covered.

Then, during the course of the treatment, the insurance provider will want to know whether the patient is getting better. Again, because the goal of home health is to drive toward improvements, you will need to report to the insurance provider whether the services provided by your agency are supporting the end goal of getting the patient out of the house.

Depending on the patient’s progress and other services that you believe need to be provided during the treatment, your agency may need to receive re-authorization or re-certification to continue seeing the patient. We understand that home health agencies are not used to dealing with this requirement because it’s very different than dealing with Medicare.

When we serve as your home health virtual intake coordinator, we will handle the entire process. We’ll work upfront on the intake and insurance verification process, then continue to provide support if your agency needs to be re-approved to continue providing care to the patient.

Contact PMB To Discuss Home Health Intake

We are committed to helping agencies navigate the unique world of supporting third-party payers for home health services. We have a dedicated subject matter expert team member for each major insurance provider, such as Aetna, Blue Cross, United Healthcare, and others.

When we serve as your home health virtual intake coordinator, we will take the stress off your team by walking through the entire intake and verification process with each insurance company. This way, we’ll feed you precise information about each patient’s benefits, the services that will be covered, how many visits you are allotted, and any patient responsibility for these services.

We work quickly and efficiently to get you started providing services. PMB will put your home health agency in the best possible position to provide care to patients in a manner where you will not overstep insurance requirements and that you will receive payment for services.

Get out ahead of this trend of home health patients using insurance and not traditional Medicare. Talk to us today about a home health intake solution that works for your agency so that you can focus on providing the best possible care to patients. We’re here to help!